Ligation clip loading device

ABSTRACT

A ligation clip loading device includes a cannula including a cannula body and an instrument lumen extending through a longitudinal axis of the cannula body, and a stack of ligation clips axially arranged about the instrument lumen. The ligation clips are accessible through a series of slots allowing for loading of an endoscopic clip applier with the ligation clips within a body cavity, such as an intra-abdominal cavity.

CROSS-REFERENCE TO RELATED APPLICATION

The present application claims the benefit of and priority to U.S.Provisional Patent Application Ser. No. 62/956,462, filed on Jan. 2,2020, the entire content of which is incorporated herein by reference.

FIELD

This disclosure is generally related to ligation clips and, moreparticularly, to a ligation clip loading device for intra-cavity loadingof ligation clips to a ligation clip applicator device.

BACKGROUND

Polymeric ligation clips typically include first and second beams thatare coupled together at one end by a pivotable connection, e.g., livinghinge, such that the first and second beams can be moved in relation toeach other between open and clamped positions. The ligation clips can beapplied to tissue endoscopically through a small diameter incision orthrough a small diameter cannula positioned through the incision tominimize trauma to a patient during a surgical procedure.

Typically, when polymeric clips are applied to tissue through a cannulaand/or stored within an endoscopic clip applier, the clips are supportedin a compressed or partially compressed state to minimize an overalldimension of the clips and facilitate delivery of the clips through thecannula or incision. Storing polymeric clips in a compressed orpartially compressed state may impact the condition of the clips whichmay impact the performance of the clips.

In minimally-invasive surgical procedures, operations are carried outwithin an internal body cavity through small entrance openings in thebody. The entrance openings may be natural passageways of the body ormay be surgically created, for example, by making a small incision intowhich a cannula is inserted.

Minimally-invasive surgical techniques may be used for placement ofligation clips within an internal body cavity, such as anintra-abdominal space, by a ligation clip application device (e.g.,endoscopic clip applier). Ligation clips are loaded into an end effectorof an endoscopic clip applier and the endoscopic clip applier clamps theligation clip at a desired site.

SUMMARY

In one aspect of the disclosure, an intra-cavity clip loading deviceincludes a cannula including a cannula body defining an instrument lumenextending along a longitudinal axis of the cannula body. A clip stack isdefined in the cannula body. The clip stack includes ligation clipsaxially arranged about the instrument lumen. Clip retention features areformed in the cannula body. Each clip retention feature holds a ligationclip.

In some aspects of the disclosure, each ligation clip includes a firstarm and a second arm defining a central region between the first andsecond arms. The instrument lumen extends through the central region.The cannula includes an inner wall and an outer wall. The inner walldefines the instrument lumen. The first and second arms of each of theligation clips are positioned between the inner wall and the outer wallof the cannula. The inner wall of the cannula separates the plurality ofligation clips from the instrument lumen to maintain a fluid integrityof the instrument lumen.

In some aspects of the disclosure, the cannula body includes slotsformed in the cannula body. Each slot is associated with a clipretention feature. Each ligation clip is accessible by a clip applierthrough a respective slot.

In some aspects of the disclosure, the first arm of each ligation clipincludes a first boss and the second arm of each ligation clip includesa second boss. The first boss and the second boss are each coupled to aclip retention feature.

In some aspects of the disclosure, the slots are covered by a sheathpositioned about the cannula body. The slots may be located proximate adistal end portion of the cannula body.

In some aspects of the disclosure, the cannula includes a mate cap andan instrument seal formed in the mate cap to maintain a predeterminedpressure in the instrument lumen.

In some aspects of the disclosure, a distal seal provides a barrierbetween an internal body cavity and the instrument lumen.

In one aspect of the disclosure, a method of robotic intra-abdominalclip loading includes robotically introducing the intra-cavity cliploading device into an intra-abdominal space. A robotic ligation clipapplication device is loaded into the intra-abdominal space. The endeffector of the ligation clip application device is robotically insertedinto a portion of the clip stack. The end effector of the ligation clipapplication device grasps the ligation clip of the plurality of ligationclips. The end effector of the ligation clip application device iswithdrawn to remove the ligation clip from the clip stack defined in thedistal end portion of the cannula body.

In some aspects of the disclosure, the end effector of the ligation clipapplication device is robotically inserted into a slot of the clip stackto grasp the ligation clip. The end effector may be robotically insertedinto the slot at a location proximate the distal end portion of thecannula body. The first arm and the second arm of the end effector maybe inserted into the portion of the clip stack to grasp the ligationclip. The first arm and the second arm of the ligation clip applicationdevice separates the ligation clip from the clip retention feature.

Other features of the disclosure will be appreciated from the followingdescription.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate aspects and features of thedisclosure and, together with the detailed description below, serve tofurther explain the disclosure, in which:

FIG. 1A is a side view of an intra-cavity clip storing and/or loadingdevice in accordance with the disclosure;

FIG. 1B is a cross-sectional view along line 1B-1B of FIG. 1A;

FIG. 2A illustrates the intra-cavity clip loading device of FIG. 1Apositioned in a body cavity adjacent to a ligation clip applicationdevice;

FIG. 2B illustrates loading of a ligation clip from the intra-cavityclip loading device of FIG. 1A to the ligation clip application device;

FIG. 3 is a side view of an intra-cavity clip loading device inaccordance with another embodiment of the disclosure;

FIG. 4 is an internal cross-sectional view of the intra-cavity cliploading device of FIG. 3;

FIG. 5 is a cross-sectional view along line 5-5 of FIG. 3;

FIG. 6 illustrates loading of a ligation clip from the intra-cavity cliploading device of FIG. 3 to a ligation clip application device;

FIG. 7 is a flow chart of a method of robotic intra-abdominal cliploading in accordance with the disclosure; and

FIG. 8 is a schematic illustration of a robotic surgical systemconfigured for use in accordance with the disclosure.

DETAILED DESCRIPTION

As used herein, the term “distal” refers to the portion that is beingdescribed which is further from a user, while the term “proximal” refersto the portion that is being described which is closer to a user.Further, to the extent consistent, any of the aspects and featuresdetailed herein may be used in conjunction with any or all of the otheraspects and features detailed herein.

As used herein, the terms parallel and perpendicular are understood toinclude relative configurations that are substantially parallel andsubstantially perpendicular up to about + or −10 degrees from trueparallel and true perpendicular.

Exemplary axes or directions such as an X-axis direction, a Y-axisdirection and a Z-axis direction may be illustrated in the accompanyingdrawings and/or described herein. As an example, the X-axis directionmay perpendicular to the Y-axis direction, and the Z-axis direction maybe orthogonal to the X-axis direction and the Y-axis direction.

“About” or “approximately” or “substantially” as used herein may beinclusive of the stated value and means within an acceptable range ofvariation for the particular value as determined by one of ordinaryskill in the art, considering the measurement in question and the errorassociated with measurement of the particular quantity (e.g., thelimitations of the measurement system). For example, “about” may meanwithin one or more standard variations, or within ±30%, 20%, 10%, 5% ofthe stated value.

Descriptions of technical features or aspects of an exemplary embodimentof the disclosure should typically be considered as available andapplicable to other similar features or aspects in another exemplaryembodiment of the disclosure. Accordingly, technical features describedherein according to one exemplary embodiment of the disclosure may beapplicable to other exemplary embodiments of the disclosure, and thusduplicative descriptions may be omitted herein.

Exemplary embodiments of the disclosure will be described more fullybelow (e.g., with reference to the accompanying drawings). Likereference numerals may refer to like elements throughout thespecification and drawings.

The intra-cavity clip loading devices described herein allowintra-cavity loading of ligation clips while still optionally providingan instrument lumen (e.g., for use by 5 mm instruments). Thus, a singleendoscopic port can be employed for intra-cavity ligation clip storingand loading of a ligation clip application device and for providingaccess to a surgical instrument through the instrument lumen extendingbetween the ligation clips.

FIGS. 1A, 1B, 2A and 2B illustrate an embodiment of an intra-cavity cliploading device 100. The intra-cavity clip loading device 100 includescannula 101 including distal cannula portion 102 defining an instrumentlumen 103 extending along a longitudinal axis “X-X” defined by thecannula 101.

A clip stack 104 is defined in the cannula 101. The clip stack 104includes ligation clips 105 axially arranged about the instrument lumen103. The clip stack 104 includes a stack of ligation clips 105 spacedapart from each other such that each ligation clip 105 can beindividually removed by a ligation clip application device 201 (see,e.g., FIGS. 2A and 2B). The ligation clip application device 201 may bea robotically controlled device (see, e.g., FIG. 8).

The ligation clips 105 each include a first arm 110 and a second arm 120positioned at opposite sides of the instrument lumen 103. The instrumentlumen 103 allows passage of a surgical instrument through the instrumentlumen 103 between the first arm 110 and the second arm 120 of each ofthe ligation clips 105.

In some aspects of the disclosure, the instrument lumen 103 of cannula101 may be omitted, and the intra-cavity clip loading device 100 mayprovide intra-cavity ligation clip loading without providing an accessport for an additional surgical instrument. Thus, the clip stack 104 maybe defined in the body of an obturator without the presence of theinstrument lumen 103.

In use, with specific reference to FIGS. 2A and 2B, the intra-cavityclip loading device 100 may be inserted and secured to an endoscopicport 150 (e.g., by mate cap 130) at a proximal end portion 112 of thecannula 101. The cannula 101 extends through a body cavity wall 200(e.g., an intra-abdominal wall). A distal end portion 114 of theintra-cavity clip loading device 100 is positioned in an intra-cavityspace 250 (e.g., intra-abdominal) such that the ligation clips 105 canbe removed by the ligation clip application device 201 without removingthe intra-cavity clip loading device 100 from the intra-cavity space.The ligation clip application device 201 may extend through a separateendoscopic port 152. The ligation clip application device 201 mayinclude an end effector 202 (e.g., jaws) configured to grasp and applyligation clips 105. The end effector 202 is configured for insertioninto slots 106 of the clip stack 104 to individually remove ligationclips 105 stored within the intra-cavity space 250.

FIGS. 3-6 illustrate an exemplary intra-cavity clip loading device 300.The intra cavity clip loading device 300 includes a cannula 301including a cannula body 302 defining an instrument lumen 303 extendingalong a longitudinal axis “X-X” defined by the cannula body 302. A clipstack 304 is defined in the cannula body 302 (e.g., at a locationproximate a distal end thereof). The clip stack 304 includes ligationclips 305 axially arranged about the instrument lumen 303. Clipretention features 501 are formed in the cannula body 302. Each clipretention feature 501 holds a ligation clip 305.

The intra-cavity clip loading device 300 may include a mate cap 330 forsecuring the intra-cavity clip loading device 300 to an endoscopic port.The mate cap 330 may include an instrument seal 401 and/or a zero seal402 for allowing access to a surgical instrument through the instrumentlumen 303. The instrument seal 401 or the zero seal 402 can maintain afluid integrity of the instrument lumen 303. A distal seal 403 may beformed at a distal end portion 314 of the cannula body 302. The distalseal 403 may include a first flap 410 and a second flap 420 for allowingpassage of a surgical instrument therethrough, while also maintaining afluid integrity of the instrument lumen 303. The distal seal 403provides a barrier between an internal body cavity and the instrumentlumen 303. It is envisioned that instrument seal 401 and zero seal 402may be incorporated directly into clip loading device 300.

As an example, the cannula body 302 may have a diameter of from about 12mm to about 15 mm, and the instrument lumen 303 may have a diameter offrom about 3 mm to about 5 mm.

Each ligation clip 305 includes a first arm 310 and a second arm 320defining a central region between the first and second arms 310 and 320.The first and second arms 310 and 320 may reversibly pivot or flex withrespect to each other through compression or flexure of a hinge 331. Theinstrument lumen 303 extends through the central region between thefirst and second arms 310 and 320 of each ligation clip 305.

With reference to FIGS. 5 and 6, the cannula 301 and cannula body 302include an inner wall 352 and an outer wall 353. The inner wall 352defines the instrument lumen 303. The first and second arms 310 and 320of each of the ligation clips 305 are positioned between the inner wall352 and the outer wall 353 of the cannula 301. The inner wall 352 of thecannula 301 separates the plurality of ligation clips 305 from theinstrument lumen 303 to maintain a fluid integrity of the instrumentlumen 303.

The cannula body 302 includes slots 306 formed in an outer surfacethereof (e.g., outer wall 353). Each slot 306 is associated with a clipretention feature 501. Each ligation clip 305 is accessible by a clipapplier (e.g., a ligation clip application device) through a respectiveslot 306. The use of separate slots 306 each employing a separate clipretention feature 501 allows each ligation clip 305 to be individuallysecurely removed by the clip applier.

The first arm 310 of each ligation clip 305 includes a first boss 332and the second arm 320 of each ligation clip 305 includes a second boss333. The first boss 332 and the second boss 333 are each coupled to aclip retention feature 501. Thus, the first and second bosses 332 and333 may be employed for securing the ligation clips 305 to correspondingclip retention features 501 in corresponding slots 306.

The slots 306 may be covered by a sheath 307 positioned about thecannula body 302. As an example, the sheath 307 may include or may beformed of plastic. The sheath 307 may assist in guiding an end effector202 of a ligation clip application device 201 into a desired slot 306,and may assist in maintaining ligation clips 305 within slots 306.

The slots 306 may each be located proximate a distal end portion 314 ofthe cannula body 302. As an example, the clip stack 304 may include astack of six ligation clips 305 and a six corresponding slots 306.

The cannula 101 and cannula body 102, or the cannula 301 and cannulabody 302 may be configured for bladeless insertion by employing a distaltip having bladeless insertion geometry (see, e.g., FIG. 3), in themanner of an obturator or the like.

FIG. 6 illustrates removal of a single ligation clip 305 through asingle slot 306 by a ligation clip application device 201. The ligationclip application device 201 may include an end effector 202 having afirst arm 210 and a second arm 220. The first arm 210 may grasp a firstarm 310 of the ligation clip 305 and the second arm 220 may grasp asecond arm 320 of the ligation clip 305. The bosses 332 and/or 333 maybe employed by the end effector 202 for grasping the ligation clip 305.The hinge 331 of the ligation clip 305 allows flexing of the first andsecond arms 310 and 320 toward or away from each other to detach theligation clip 305 from the clip retention feature 501. Thus, theligation clip 305 may be freed from the clip retention feature 501 andretracted out of slot 306 while being securely grasped by end effector202 of ligation clip application device 201.

FIG. 7 is a flowchart illustrating a method of robotic intra-abdominalclip loading. The method includes robotically introducing theintra-cavity clip loading device 100 having the clip stack 104 into anintra-abdominal space (step 701; see, e.g., FIGS. 2A and 2B—intra-cavityspace 250). The method includes introducing a robotic ligation clipapplication device 201 into the intra-abdominal space (step 702). Theend effector 202 of the ligation clip application device 201 isrobotically inserted into a portion (e.g., a slot 106) of the clip stack104 (step 703). The end effector 202 of the ligation clip applicationdevice 201 grasps the ligation clip 105 (step 704). The end effector 202of the ligation clip application device 2012 is withdrawn to remove theligation clip 105 from the clip stack 104 (step 705; see, e.g., FIG. 6).

The end effector 202 of the ligation clip application device 201 isrobotically inserted into the slot 106 of the clip stack 104 to graspthe ligation clip 105. The end effector 202 may be robotically insertedinto the slot 106 (e.g., at a location proximate the distal end portion114 of the cannula body 302). The first arm 210 and the second arm 220of the end effector 202 may be inserted into the portion (e.g., the slot106) of the clip stack 104 to grasp the ligation clip 105. The first arm210 and the second arm 220 of the ligation clip application device 201separates the ligation clip 105 from the clip retention feature 501.

The various embodiments disclosed herein may also be configured to workwith robotic surgical systems and what is commonly referred to as“Telesurgery.” Such systems employ various robotic elements to assistthe surgeon and allow remote operation (or partial remote operation) ofsurgical instrumentation. Various robotic arms, gears, cams, pulleys,electric and mechanical motors, etc. may be employed for this purposeand may be designed with a robotic surgical system to assist the surgeonduring the course of an operation or treatment. Such robotic systems mayinclude remotely steerable systems, automatically flexible surgicalsystems, remotely flexible surgical systems, remotely articulatingsurgical systems, wireless surgical systems, modular or selectivelyconfigurable remotely operated surgical systems, etc.

The robotic surgical systems may be employed with one or more consolesthat are next to the operating theater or located in a remote location.In this instance, one team of surgeons or nurses may prep the patientfor surgery and configure the robotic surgical system with one or moreof the instruments disclosed herein while another surgeon (or group ofsurgeons) remotely controls the instruments via the robotic surgicalsystem. As can be appreciated, a highly skilled surgeon may performmultiple operations in multiple locations without leaving his/her remoteconsole which can be both economically advantageous and a benefit to thepatient or a series of patients.

The robotic arms of the surgical system are typically coupled to a pairof master handles by a controller. The handles can be moved by thesurgeon to produce a corresponding movement of the working ends of anytype of surgical instrument (e.g., end effectors, graspers, knifes,scissors, etc.) which may complement the use of one or more of theembodiments described herein. The movement of the master handles may bescaled so that the working ends have a corresponding movement that isdifferent, smaller or larger, than the movement performed by theoperating hands of the surgeon. The scale factor or gearing ratio may beadjustable so that the operator can control the resolution of theworking ends of the surgical instrument(s).

The master handles may include various sensors to provide feedback tothe surgeon relating to various tissue parameters or conditions, e.g.,tissue resistance due to manipulation, cutting or otherwise treating,pressure by the instrument onto the tissue, tissue temperature, tissueimpedance, etc. As can be appreciated, such sensors provide the surgeonwith enhanced tactile feedback simulating actual operating conditions.The master handles may also include a variety of different actuators fordelicate tissue manipulation or treatment further enhancing thesurgeon's ability to mimic actual operating conditions.

FIG. 8 illustrates a medical work station shown generally as workstation 1000 and generally may include a plurality of robot arms 1002,1003; a control device 1004; and an operating console 1005 coupled withcontrol device 1004. Operating console 1005 may include a display device1006, which may be set up in particular to display three-dimensionalimages; and manual input devices 1007, 1008, by means of which a person(not shown), for example a surgeon, may be able to telemanipulate robotarms 1002, 1003 in a first operating mode.

Each of the robot arms 1002, 1003 may include a plurality of members,which are connected through joints, and an attaching device 1009, 1011,to which may be attached, for example, a surgical tool “ST” supportingan end effector 1100, in accordance with any one of several embodimentsdisclosed herein, as will be described in greater detail below.

Robot arms 1002, 1003 may be driven by electric drives (not shown) thatare connected to control device 1004. Control device 1004 (e.g., acomputer) may be set up to activate the drives, in particular by meansof a computer program, in such a way that robot arms 1002, 1003, theirattaching devices 1009, 1011 and thus the surgical tool (including endeffector 1100) execute a desired movement according to a movementdefined by means of manual input devices 1007, 1008. Control device 1004may also be set up in such a way that it regulates the movement of robotarms 1002, 1003 and/or of the drives.

Medical work station 1000 may be configured for use on a patient 1013lying on a patient table 1012 to be treated in a minimally invasivemanner by means of end effector 1100. Medical work station 1000 may alsoinclude more than two robot arms 1002, 1003, the additional robot armslikewise being connected to control device 1004 and beingtelemanipulatable by means of operating console 1005. A medicalinstrument or surgical tool (including an end effector 1100) may also beattached to the additional robot arm. Medical work station 1000 mayinclude a database 1014, in particular coupled to with control device1004, in which are stored, for example, pre-operative data frompatient/living being 1013 and/or anatomical atlases.

From the foregoing and with reference to the various figure drawings,those skilled in the art will appreciate that certain modifications canalso be made to the disclosure without departing from the scope of thesame. While several embodiments of the disclosure have been shown in thedrawings, it is not intended that the disclosure be limited thereto, asit is intended that the disclosure be as broad in scope as the art willallow and that the specification be read likewise. Therefore, the abovedescription should not be construed as limiting, but merely asexemplifications of particular embodiments. Those skilled in the artwill envision other modifications within the scope and spirit of theclaims appended hereto.

What is claimed is:
 1. An intra-cavity clip loading device, comprising:a cannula including a cannula body defining an instrument lumenextending along a longitudinal axis of the cannula body; and a clipstack defined in the cannula body, the clip stack including: a pluralityof ligation clips axially arranged about the instrument lumen; and aplurality of clip retention features formed in the cannula body, eachclip retention feature of the plurality of clip retention featuresholding a ligation clip of the plurality of ligation clips.
 2. Thedevice of claim 1, wherein each ligation clip of the plurality ofligation clips includes a first arm and a second arm defining a centralregion therebetween, and wherein the instrument lumen extends throughthe central region defined by the first arm and the second arm of eachligation clip of the plurality of ligation clips.
 3. The device of claim2, wherein the cannula includes an inner wall and an outer wall, theinner wall defining the instrument lumen, and wherein the first andsecond arms of each of the plurality of ligation clips are positionedbetween the inner wall and the outer wall of the cannula.
 4. The deviceof claim 3, wherein the inner wall of the cannula separates theplurality of ligation clips from the instrument lumen to maintain afluid integrity of the instrument lumen.
 5. The device of claim 2,wherein the first arm of each ligation clip of the plurality of ligationclips includes a first boss, wherein the second arm of each ligationclip of the plurality of ligation clips includes a second boss, andwherein the first boss and the second boss are each coupled to a clipretention feature of the plurality of clip retention features.
 6. Thedevice of claim 1, wherein the cannula body includes a plurality ofslots formed therein, wherein each slot of the plurality of slots isassociated with a clip retention feature of the plurality of clipretention features, wherein each ligation clip of the plurality ofligation clips is accessible by a clip applier through a respective slotof the plurality of slots formed in the cannula body.
 7. The device ofclaim 6, wherein the slots of the plurality of slots are covered by asheath positioned about the cannula body.
 8. The device of claim 6,wherein the plurality of slots are located proximate a distal endportion of the cannula body.
 9. The device of claim 1, wherein thecannula includes a mate cap and an instrument seal formed in the matecap to maintain a predetermined pressure in the instrument lumen. 10.The device of claim 9, further including a distal seal configured toprovide a barrier between an internal body cavity and the instrumentlumen.
 11. An intra-cavity clip loading device, comprising: a cannulaincluding a cannula body and an instrument lumen extending through alongitudinal axis of the cannula body; and a clip stack positioned at adistal end portion of the cannula body and including a plurality ofligation clips loaded therein, wherein the plurality of ligation clipsare axially arranged about the instrument lumen.
 12. The device of claim11, further including a sheath positioned about the distal end portionof the cannula body, the sheath defining a plurality of slots, each ofthe plurality of slots configured to provide access to a ligation clipof the plurality of ligation clips.
 13. The device of claim 11, whereineach ligation clip of the plurality of ligation clips includes a firstarm and a second arm defining a central region therebetween, and whereinthe instrument lumen extends through the central region defined by thefirst arm and the second arm of each ligation clip of the plurality ofligation clips.
 14. The device of claim 13, wherein the cannula includesan inner wall and an outer wall, the inner wall defining the instrumentlumen, and wherein the first and second arms of each of the plurality ofligation clips are positioned between the inner wall and the outer wallof the cannula.
 15. The device of claim 14, wherein the inner wall ofthe cannula separates the plurality of ligation clips from theinstrument lumen to maintain a fluid integrity of the instrument lumen.16. A method of robotic intra-abdominal clip loading, comprising:robotically introducing an intra-cavity clip loading device into anintra-abdominal space, the intra-cavity clip loading device including: acannula including a cannula body; a clip stack defined in a distal endportion of the cannula body; and a plurality of ligation clips loaded inthe clip stack; introducing a robotic ligation clip application deviceinto the intra-abdominal space, the ligation clip application deviceincluding an end effector configured to grasp a ligation clip of theplurality of ligation clips; robotically inserting the end effector ofthe ligation clip application device into a portion of the clip stack;grasping, by the end effector of the ligation clip application device,the ligation clip of the plurality of ligation clips; and withdrawingthe end effector of the ligation clip application device to remove theligation clip of the plurality of ligation clips from the clip stackdefined in the distal end portion of the cannula body.
 17. The method ofclaim 16, wherein the intra-cavity clip loading device further includesa sheath positioned about the distal end portion of the cannula body,the sheath defining a plurality of slots, each slot of the plurality ofslots configured to provide access to one ligation clip of the pluralityof ligation clips, and wherein the method includes robotically insertingthe end effector of the ligation clip application device into a slot ofthe plurality of slots to grasp the ligation clip of the plurality ofligation clips.
 18. The method of claim 17, wherein the plurality ofslots are located proximate the distal end portion of the cannula body,and wherein the method includes robotically inserting the end effectorof the ligation clip application device into the slot of the pluralityof slots at a location proximate the distal end portion of the cannulabody.
 19. The method of claim 16, wherein the end effector of theligation clip application device includes a first arm and a second arm,and wherein the method includes robotically inserting the first arm andthe second arm into the portion of the clip stack to grasp the ligationclip of the plurality of ligation clips.
 20. The method of claim 19,wherein the intra-cavity clip loading device further includes a clipretention feature configured to hold the ligation clip of the pluralityof ligation clips, and wherein the method includes the first arm and thesecond arm of the ligation clip application device separating theligation clip of the plurality of ligation clips from the clip retentionfeature.